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S.R. Richardson, L. Gnanaraj; Systematic Review of the Management of Intermittent Distance Exotropia . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2751.
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Purpose: The management of intermittent distance exotropia (IDEX) is controversial with no clear guidance as to indications for and the most effective type of intervention. We undertook a systematic review to assess the effects of various surgical and non-surgical treatments in subjects with IDEX and to determine the significance of factors such as age with respect to outcome. Methods: Search strategy & criteria Our predetermined selection criterion was randomised-controlled trials of any surgical or non-surgical treatment for IDEX. e searched the Cochrane Central Register of Controlled Trials - CENTRAL (Issue 2 2002), MEDLINE (1966 to March 2002), EMBASE (1980 to February 2002) and LILACS (1966 to 2002). We manually searched the British Orthoptic Journal, proceedings of European Strabismological Association, International Strabismological Association and American Academy of Paediatric Ophthalmology and Strabismus meeting. In addition clinicians and researchers active in this field were contacted for information about further published or unpublished studies. Data collection & analysis Each reviewer independently assessed study abstracts identified from database and manual searches. Reviewer analysis was then compared and full papers for appropriate studies were obtained. Results: No studies were found that met our selection criteria and therefore none were included for analysis. The available literature consists mainly of retrospective reviews and some prospective non-randomised trials. Although yielding useful results, these are difficult to compare and analyse due to a large variation in the definition, intervention criteria and outcome measures. Conclusions: There is general agreement that non-surgical treatment is most appropriate in small angle deviations or as a supplement to surgery. Optimal timing of surgical intervention could not be concluded. This review clearly demonstrates a need for carefully planned clinical trials to improve the evidence for the management of IDEX.
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